Today: May 17, 2020

My office

It’s taken me 5 months to sit down and write again. I have created this cozy coffee house writing space in my basement. I have everything I need, a comfortable chair, my ipad and Bluetooth keyboard, iPhone and wireless earbuds. Water is heating in the tea kettle on the stove so that I can make a chai tea latte.

My cats run and play. Shadow darts down the stairs and jumps in to the hammock we created, hiding from his sister, ready to pounce when she returns. Sunshine is no where to be found…

Life ebbs and flows

March 26 the governor declared a state of emergency and issued a shelter in place order. The corona virus had arrived in the US and fear set in across the country. The virus was spreading rapidly and people were dying. COVID 19 became a daily headline.

I suddenly had increased hours at the nursing home where I work on an as needed basis. The following weeks, I had no hours. The facility locked down, limiting new admissions, limiting the therapy caseload, limiting the need for additional therapists.

Hope

I discovered that even part time employees can collect unemployment. New federal funding and orders also now made it easier for individuals to receive unemployment due to reduced hours from corona virus. It was not so easy to get an account set up but a week later, I had one and then waited. Four weeks later, I received my first unemployment check and then I figured out how the system worked and what was required to qualify for unemployment each week. Every state has different requirements and different maximum weekly distributions. NC is one of the lowest.

North Caroline is beautiful with mountains and beaches and bass-ackwards when it comes to government programs and policies

The Times They Are A-Changin’

Come writers and critics
Who prophesize with your pen
And keep your eyes wide
The chance won’t come again
And don’t speak too soon
For the wheel’s still in spin
And there’s no tellin’ who
That it’s namin’
For the loser now
Will be later to win
For the times they are a-changin’

Life will never be the same

We hear this phrase often now. I have said or thought this many times in my life during the many challenges my family has experienced. Yet, each day is a new experience and so the happenings of the prior day, render life Different.

I am both saddened and amused seeing adds on tv showing people connecting more… Parents teaching children at home, parents working from home, families spending more time together. I shake my head and wonder why it has taken a pandemic to get people to prioritize relationships and spend more time connecting.

My family has lived this way for a long time. My husband works from home and has since we decided to start a family. We have been homeschooling our children their entire lives. My husband and I have been growing a business together helping families… to connect.

Connection. And Balance

I have friends on both sides of the fence. Regarding this pandemic and government regulations and controls. We want to protect people and reduce deaths and we want the freedom to live our life. The dichotomy has contributed to the divisiveness that has been growing in the US. My personal.belief encompass both philosophies. And I wonder, why does it have to be one way or the other?

Some might say, you can’t have both.

I am hear to challenge the idea that we have to be on the side of Personal freedoms OR on the side of saving lives.

I have been concerned from day One about restrictions. I work with the elderly and confining them to their room in a nursing home or an assisted living facility can have a negative impact on their health. And keeping seniors in their homes can be detrimental to their health. Yet, these are the very people who are most at risk for complications from the virus and who suffer a higher mortality rate.

Are we merely delaying the inevitable spread of this disease?

I believe in boosting our natural immune system to fight illness and maintain health. The naturopathic medicine philosophy has been a part of my life and my immediate family for many years. Breastfeeding is the best way to begin building our immune system and far more effective than any vaccine. My younger two children never had an ear infection. I have been so much healthier since embracing this philosophy, including improving my diet and using foods to boost my immune system.

How do we allow for the freedom to live our life and protect the vulnerable population, minimize their risk for serious illness and death.

If we all followed a naturopathy philosophy of health, would a quarantine be necessary? Allowing personal freedoms means allowing people to make their own choices when it comes to their health, even if it means they choose things that diminish their physical health. We all choose things that are not in our best interests at some time in our life. We are human and living in this physical experience.

What if we looked at this pandemic from a spiritual perspective?

I think we might label it in a different way then by calling it a pandemic. From a spiritual perspective we could refer to this time as…

The time we became so wrapped into our physical expression of our body that we both lost sight of our higher purpose and also reconnected with our inner selves

It needs a shorter title, or does it?

We live in a culture of quick fixes, instant responses and fear inducing headlines.

From a spiritual perspective, I can see that I still have the freedom to live and be who I am even within the restrictions on entering the community. I can be my true self despite the government regulations and control. Yet, when I think of parenting and raising children, I see it differently. As adults, this is only a small period of time in our life but for our children, this is their childhood. How they experience life has an impact on how they develop and limiting their experiences can have a detrimental affect on their mental health.

Any drastic change, sudden change or disruption to our routine can have a detrimental affect on our mental health, for all of us, no matter our age. It can and does also impact our physical health as well as our mental health in a cyclical manner.

I invite you to share your perspective. I challenge you to find a blending of the needs of personal freedoms and protecting the vulnerable. Please share. I would love to revisit this idea with the input from others. Respond in comments or feel free to private message me if you prefer to be anonymous.

I leave you with these thought provoking lyrics as you contemplate. These words are even more powerful listening to Kenny Loggins sing them:

Where are the dreams that we once had?
This is the time to bring them back.
What were the promises caught on the tips of our tongues?
Do we forget or forgive?
There’s a whole other life waiting to be lived when…
One day we’re brave enough
To talk with Conviction of the Heart.
And down your streets I’ve walked alone,
As if my feet were not my own
Such is the path I chose, doors I have opened and closed
I’m tired of living this life,
Fooling myself, believing we’re right, when…
I’ve never given love
With any Conviction of the Heart
One with the earth, with the sky
One with everything in life
I believe we’ll survive
If we only try…
How long must we wait to change
This world bound in chains that we live in
To know what it is to forgive,
And be forgiven?
It’s been too many years of taking now.
Isn’t it time to stop somehow?
Air that’s too angry to breathe, water our children can’t drink
You’ve heard it hundreds of times
You say your aware, believe, and you care, but…
Do you care enough
To talk with Conviction of the Heart?

Many thanks to Bob Dylan, Kenny Loggins, Azlyrics, YouTube, and to all of you who read and share my posts.

December 4, 2019

Five weeks ago I was sitting in a hospital room waiting on results.

Five weeks ago my concern was that they were going to send my husband home from the hospital with no answers.

I left the hospital that morning to take my youngest to a therapy appointment.

I did not know I would return to find out he had failed his stress test.

I did not know the critical care ambulance would be driving him to the main hospital.

To Presbyterian main where he spent 12 days recovering from his heart attack 8 years earlier.

I did not know he would undergo coronary artery bypass graft surgery, CABG,

Open heart surgery

On November 1,2019, my husband had open heart surgery

His heart was exposed

His heart was stopped, his lungs were deflated, he was intubated and put on a heart and lung machine while they replaced his clogged arteries

The arteries that supply blood to his heart so that the heart can beat

So the heart can beat and send blood to the lungs and to the body

So he can live

Genetics,

And stress

Stress

Stress can wreak havoc on the body

He does not look like a man with heart disease

He never has

He is tall and thin

Unlike his cardio thoracic surgeon who has a large gut

Ironic

His surgeon was wonderful and even personal

We are grateful for him

Yet, it has been hard for me to look at all the overweight people

To see obese people in the hospital waiting rooms, in the cafeteria

Not the people in the hospital beds, but the ones visiting

And wonder why my husband is the one with heart disease

It is what it is

The past month has been a whirlwind

Driving, waiting, wondering

Juggling responsibilities as a parent, as a wife, as an employee

Driving my family members to appointments and making sure the kids were fed

Being there at the hospital most hours of the day to hear what the doctors had to say

Accommodating the lack of schedule in the hospital

Managing my two prn jobs, where I work as needed

Canceling work hours and trying to find work hours

The game is continuous

The flexibility is my life line

The flexibility is a must for being the mom I choose to be

For being a homeschool parent

For putting my family first, making parenting my top priority

I used to say, if I could only get paid to be a parent

Now, I have that opportunity.

Don and I have spent hours developing our program for families

We have given presentations and spoken to groups of parents

We have been growing our business

To help families who have challenges, where anxiety resides in the home

For families with children with behavior issues

For families looking for a better way to help their children thrive

On October 1, when I lost nearly all of my regular hours at my primary job,

I declared to the universe that I was ready

I said, “I am all in”

I knew it was time to give 100% to growing our business

To my writing, growing my blogs and working toward that book I will write

To spending more time growing our business, speaking and finding clients

I need to continue working at my “jobs” as we grow our business

Yet, the stress of finding hours and dealing with the latest change in reimbursement for therapy services at skilled nursing rehabilitation facilities

The second change of its kind in the course of my 27 year career as an Occupational Therapist

I declared the stress of all of this, the job stress, behind me

I have bigger and better things growing and am working toward

No longer depending on that income to support my family

Live is so unpredictable

When I was a child, I used to find my life

Boring

Most children declare that sentence often,

“I’m bored.”

My life now is anything but boring

I joke about wishing I was bored

I am going within

I am going within to find the strength and fearlessness that I felt on October 1

When I declared to the universe, “I am all in”

Maybe Don undergoing urgent, but not emergent bypass surgery

Is what we needed to dive fully into our business

Now his heart can function better

Now his arteries are free and clear

Now we know he has at least 10 or 20 years of life…or more

Now we can live more freely

I have gotten wrapped back into the stress over the past several weeks

As I have poured time and energy into finding work hours

Finding hours to make up for missed hours

Finding work hours to meet our expenses, or at least not completing deplete our savings

The savings we had build while I worked 30-40 hours all summer

Today

Today, I declare to the universe once again

I am all in

I am ready to dive back into my chosen life

I am ready to stop the life of getting through the days

I am ready to begin to live with more intention

I am ready to live the life I choose

I am a writer

I am a parent

I am a wife and a partner to an amazingly strong and resilient man

I am a parenting coach, a behavior transformation specialist

I am a business owner, a co-owner of

Focused Healthy Family

Even amounts the chaos that life can bring,

Our vision and intentions for our family have focus and purpose

We might lose sight of our core values and beliefs from time to time

Yet, we have done the work and continue to do the work

To be the best parents we can be, to empower our children to be the best they can be

Our desire and our mission for our business is…

To help other families find and achieve greater harmony and balance in their own homes

To live with intention, connection, and respect

To collaborate with their children

To have coping strategies to deal with anxiety and other challenges

To find the life that works best them, so that each member of the family can be empowered to be fully who they are

Life will still be messy at times

We will make mistakes

Life is unpredictable

How we handle life is the key

We can learn to respond to life challenges

Instead of reacting to the challenges,

Instead of reacting to our children’s behavior

We can choose our words and our actions

We can choose a new way of parenting

And live a more empowered and healthy life with our children.

Healthcare Changes: Patient Directed?

Yesterday was my 50th Birthday and there will be more posts to follow on a “non-political note”. (Although, I believe that politics is a part of our every day life and can not be separated out from life.)

Yesterday I declared to release the negativity from the healthcare industry and its affects on my life. Yet, Today, I read something that that compelled me to respond.

If I do not speak up and speak out so all can be informed, then I am failing myself and failing humanity.

Change can not happen in the environment of silence and keeping our thoughts to ourselves.

Silence is deadly… I am empowered to speak out.

I would like to share with you a story on how our president and his government appointment employees are helping the economy and in particular health care.

Please read and please share.

To give you perspective on his “positive”effects on the economy:

The president appoints the director of CMS (Center for Medicare and Medicaid Services) which is the government entity that decides about reimbursement for health care services. CMS just instituted the new PDPM in physical rehabilitation health care … “Patient Driven Payment Model”

I am a health care professional and have been for 27 years.

I am an Occupational Therapist. I am the person who helps your mother recover after a stroke, or breaks a hip, goes into respiratory failure and is told she may not live. I am the person that might help you someday recover from a hip or knee replacement or recover from a car accident.

I received a 3% pay cut effective October 1, and then WITHOUT warning, had a reduction in hours from 30-40hours/week to 0 hours one week and then 8.5 hours the next. I have no idea what my hours will be in the coming weeks…

I am being pushed out of this area of work that I love and have enjoyed doing for the past 27 years. I enjoy being an Occupational Therapist and using my education and experience to help others. I do not enjoy the system that governs the financial aspects of my job which in turn affects my ability to do my job well.

I can not do my job they way I learned to when I completed college and my training because INSURANCE companies dictate how I do my job. I see how this change that “claimed to be in the name of putting the PATIENTS back in he driver’s seat of care, is making it WORSE for the patients and worse for the staff who helps them to return home, to deal with their illness/ injury, to educate their families and help them with the transition back home or to a new place to live.

So, when you or your loved one has a stroke or is in a car accident or any other physical illness or injury that renders you/them unable to return home directly from the hospital, I will not be there to aid in his/your recovery. I have 27 years experience with working in stroke and physical rehabilitation recovery. I had excellent training with co-workers and an environment that facilitated education and learning with my first job out of college…yet, this type of setting no longer exists.

Instead you will get a less experienced therapist, likely someone recently out of college, who has had to work in an environment that is not conducive to learning and professional growth because productivity standards now dictate how we do our job and there is little time for mentoring new graduates and when I take the time to do that…I get a reduction in hours because my productivity (which means billable hours of direct skilled therapy services) has dropped.

When I take extra time to complete an evaluation so that these new therapists have a plan of care to follow to help them better do their job, I get a reduction in hours because my productivity is below 85%.

Many therapists work off the clock to maintain their 85% productivity so not to loose their job. No one speaks of it, but it has been happening for a long time.

I am already employed by several companies and continuously seek to gain hours and additional employment. My rate of pay has not changed in 20 years. I am growing a new business while doing all of this.

You know, I am one of those “lazy democrats who seek government assistance” like Medicaid for my children’s health insurance and was just dropped from that because I “made too much money” ..that was a month before the change… so now I get to use my “lazy-ass self”, to reapply for health insurance for my children, while searching for new work, growing a business, helping my children with special medical needs who will be without health insurance beginning Nov 1…because it takes forever to get the coverage again.

Now tell me how our current president and his government appointed employees are helping the economy?

Oh, that’s right, this new change, the Patient Driven Payment Model, is code for “How can we save insurance companies money and help them grow their profit at the expense of the patients and at the expense of the professionals who provide care to patients.”

I will be ok.

The changes empower me like the universe “kicking me in the pants” to fully move forward into my writing and my new business helping families. The business, my husband and I have been growing recently and the business that takes the passion I have had since I became a mother 22 years ago and putting it to use.

Yet, I still am sad that the system is failing people. It is failing our elderly. It is failing people who need physical rehabilitation. It is failing the very people who help the inured, ill and disabled.

I will be ok. I only hope that my speaking out empowers others to make their voice hear and counted, to vote, and to help effect change.

And now back to our regularly scheduled programming…my 50th birthday celebration adventure!

Changes in Healthcare, Changes in Me

Twisted Sister sings to me as I research the history of changes in rehabilitation services under Medicare. The more I research, the more validation I am finding in my experience and opinions. And the more I feel the importance of speaking out…

We’ve got the right to choose it

There ain’t no way we’ll lose it

This is our life, this is our song…

I have worked in the “health care system” for over 27 years, known to many of my like-minded friends as the “sick- care system”.

My career has been taken over by government entities who have changed the reimbursement system for skilled therapy services for the second time in 20 years.

The insurance industry is the one who runs the show and now decides how long the patients need therapy services.

When I began my career, after graduating from a certified and well respected Occupational Therapy program at Elizabethtown College, part of my role as an evaluating therapist was/is to determine the need for skilled Occupational Therapy, set goals, monitor progress, and determine when there is no longer the need for skilled services.

I now have very little say in how long someone receives therapy services in adult and geriatric rehab under Medicare Part A services, at skilled nursing facilities where most of short term rehabilitation now happens.

Twenty-seven years ago, physical rehabilitation began at rehabilitation hospitals. Now, most people can no longer head from the hospital to an acute care rehab hospital, as the changes in PPS in 1999/2000 changed the criteria for admission to acute rehabilitation facilities pushing people to go for rehabilitation at nursing homes, with the new tittle of “sub acute rehab”.

Why did this happen?

From my perspective as an Occupational Therapist who has been practicing for 27 years and has lived through these changes, the mighty dollar has taken higher priority than quality patient care.

Sure, the people involved in establishing these changes, the branch of government now known as The Centers for Medicare and Medicaid Services, CMS, including the head of the organization who is appointed by the president, would argue that it is to stop fraud and to improve patient care.

On November 29, 2016, President-elect Donald Trump nominated Verma to serve as administrator of the Centers for Medicare and Medicaid Services, the Health Department agency that oversees Medicare, Medicaid, and the insurance markets.^[16] On March 13, 2017, the United States Senate confirmed her nomination in a 55–43 vote.^[17] One of her first actions was to send a letter to the nation’s governors urging them to impose insurance premiums for Medicaid, charge Medicaid recipients for emergency room visits, and encourage recipients to get jobs or job training.

Patient’s Over Paperwork:

Taken directly from the CMS.gov website:

Reduce unnecessary regulatory burden to allow providers to concentrate on their primary mission: improving patient health outcomes.

• CMS Administrator Seema Verma launched the “Patients over Paperwork” initiative in 2017, in accord with President Trump’s Executive Order that directs federal agencies to cut the red tape. This helps patients by allowing doctors and non-physician practitioners to focus on care instead of paperwork.

• CMS is eliminating overly-burdensome and unnecessary regulations and guidance to allow providers and suppliers to focus on their primary mission – improving their patients’ health.

• CMS is removing barriers to unleashing innovation.

• CMS is partnering with clinicians, providers and suppliers, administrators, support staff and beneficiaries to ensure we are focusing on the needs of patients.

I call “Bullshit!”

Suppliers and beneficiaries?

Is that code for health insurance companies?

I have MORE paperwork than I did 27 years ago and will have even more now with these new changes and have less time for actual patient care.

This is my favorite part of this information:

Our actions have delivered results

• Saved the healthcare system at least $5.7 billion through 2021.

• Eliminated at least 40 million hours of burden through 2021 giving that time back to providers and suppliers to spend with their patients and not on needless paperwork.

• Heard from over 2,000 clinicians, administrative staff and leaders, and beneficiaries through listening sessions and in-person visits throughout the country.

“Saved the healthcare system at least $5.7 billion through 2021”

Who have they saved $5.7 billion for?

THE INSURANCE COMPANIES!

And these changes both with PPS in 1999 and now in 2019 with PDPM have directly affected the lives of the healthcare professionals who provide these services.

There is a HUGE difference between rehabilitation services in 1992 and what is now happening in 2019.

I worked in an Acute Rehabilitation Hospital in 1992, my first job out of college. It was a great learning experience and an excellent facility. Sure, I hated many aspects of working for this large hospital system, yet I would not change beginning my career there. I left after three years to escape the strict schedule and stress of hospital policies.

I took a job in a Nursing home that had both long term care and “sub-acute care”, the new buzzword for rehabilitation services. My new job had flexible hours and a 35% pay increase. Yet, I soon found out that my role of being a skilled Occupational Therapist looked very different in this new setting and I had to spend less time being a skilled therapist and without the environment of a rehabilitation setting where the focus was on patient care and rehabilitation. And without all the necessary tools to do my job and the experienced professionals that I was surrounded by at my prior job.

I have been working in adult and geriatric physical rehabilitation since that time in various settings including nursing homes with “sub acute rehabs”, home health, and outpatient centers for assisted living and independent living residents.

When the PPS system was being developed, I agreed that there needed to be a change. Yet, the change was from one extreme to the other. The results were not better patient care, but less staff to patient ratios, a shift from quality of care to the number of minutes of therapy equating to a dollar amount, affecting not only the patients but also the staff whose job was to provide needed care for these patients.

Five years after I began working in nursing homes, I suffered a pay cut, reduction in benefits, and was shuffled to different facilities. My position moved from working 4 miles from my home with a 32 hour work week, hours reduced at my request to have time with my 2 year old child and still have full time benefits; to traveling to 2 different facilities in one day, traveling 147 miles round trip each day. I had an amazing boss at the time who negotiated some extra pay in addition to the standard pay for travel between the two facilities.

After traveling like this 5 days each week for a while, she then helped me to switch to working 4 days a week rather than 5 days to return to something closer to my “reduced 32 hour week”.

My other option, was to loose my job. Everyone was cutting staff. There weren’t many jobs to be found.

I spent 9 months searching for a new job. I eventually got a job offer for part time work in home health care which gave me more freedom in some ways but also evolved into traveling a larger area to see patients in 3 different NC counties, Stanley, Union, and Anson. I live in the corner of Mecklenburg county where it meets Stanley, Union, and Cabarrus Counties (see image below: Mecklenburg county is the pink county on far left)

Flash forward to 2019:

Over the past several months, everyone has been talking about the new reimbursement system, PDPM, Patient Driven Payment Model.

I wasn’t very worried about it, listening to my fellow therapists and co-workers “panic” and share the information they had from other employers and our mutual employer. I had gone through changes in the reimbursement system before. I have had issues with this system, and knew a change was needed. I wasn’t surprised that the change would be a pendulum swing to the opposite end of the spectrum.

For the second time in my career, my rate of pay is being reduced.

I had about a months notice for this pay reduction. 3% pay decrease starting October 1, 2019.

“This is minor compared to what I went through in 2000” I told my young coworkers.

From everything I heard, I was not too worried. It appeared that my employer was handling it calmer than other places. I felt secure because even though I am a prn employee, working on an as needed basis, I have had 30-40 hours of work lately because one full time therapist has been on medical leave. And, had plenty of hours before that happened. They needed me.

I knew I would likely have less hours. I was aware of the industry push to use less prn employees and have full timers flex hours and work weekends. This concept had affected me already at my last job less than 2 years ago.

I work primarily weekends because that his been my only semi-guaranteed way to get hours.

Because of the anticipated change, I had been working as many hours as needed while they were available. I typically worked between 15-25 hours before and now began working 30-40 hours. I had several weeks where I had to pay close attention to my hours so as not to go into overtime. Paying prn employees overtime is a big no-no in healthcare. As a prn employee, I have no benefits and so my rate of pay is higher than full time therapists. Yet, my higher rate of pay is the same prn rate as it was 22 years ago.

Flash forward to Monday, September 20, 2019:

11:16 am: I received a text saying I was not needed to come in for the 2-3 hours of work that I had agreed to on Friday. Not surprising, this happens all the time.

My reply:

OK, Hoping I will still be needed Friday with XXXXX having the day off, I had agreed to cover for her.

Working prn, my boss confirms if I am needed to work the next day. If I don’t hear, I check in to confirm I am needed to work. This has been the typical practice for years and across several employers. I have always been frustrated by last minute call-offs, but despite my efforts to change this, the best result I have gotten has been a confirmation text the day before. My current boss has been the most consistent with this practice and this employer has been my best experience working prn in a nursing home/rehab center.

I was then told that I would not be needed on Friday, And likely for the weekend as well.

There were changes that even my boss wasn’t expecting.

I like my current employer and am happy I am working for this company and not somewhere else. I share this because this is an across the board change affecting all of the Occupational, Physical, and Speech Language Therapists who work in rehabilitation where Medicare is the primary reimbursement system.

As is always the case, the need for prn coverage changes constantly and usually, how much help is needed, is not known until the day before because of fluctuations in the census.

This is good, I can now devote more time to the business my husband and I have recently started.

But wait, we are finally out of major credit care debt and I have been working extra hours to pay off debt and to build our savings.

This is good, Gina, the universe is telling you, once again, to pour your time and energy into your new business and writing pursuits.

Will I have any hours over the next week?

I have no idea.

Surely, they will need me once the census picks up.

Right?

We’ll fight the powers that be, just
Don’t pick our destiny ’cause
You don’t know us, you don’t belong

Oh, we’re not gonna take it
No, we ain’t gonna take it
Oh, we’re not gonna take it anymore

Oh, you’re so condescending
Your gall is never ending
We don’t want nothin’, not a thing from you

Your life is trite and jaded
Boring and confiscated
If that’s your best, your best won’t do

It will be ok, Gina, you can finally write more and work on the book that has been inside of you for so long.

It will be ok, Don and I have come along way with our new business and have speaking engagements set up and we are working with a business coach.

This is time to step up and dive in to a new chapter of my career as an Occupational Therapist. I can use my experience and talents in a new way and outside the healthcare system.